|
AIRWAY EXCHANGE CATH 19FR
|
Facility
|
OP
|
$276.15
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$276.15 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$270.63
|
| Rate for Payer: Aetna of WY Medicare |
$182.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$265.10
|
| Rate for Payer: Altius Commercial |
$265.10
|
| Rate for Payer: Beech Street Commercial |
$270.63
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$226.72
|
| Rate for Payer: Cash Price |
$193.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$267.87
|
| Rate for Payer: Cigna of WY Commercial |
$270.63
|
| Rate for Payer: Entrust Commercial |
$262.34
|
| Rate for Payer: First Choice Health Commercial |
$262.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$262.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$160.17
|
| Rate for Payer: HealthUtah PPO |
$276.15
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$267.87
|
| Rate for Payer: Multiplan Medicare/VA |
$152.16
|
| Rate for Payer: One Health Plan of WY PPO |
$270.63
|
| Rate for Payer: PacificSource Commercial |
$248.54
|
| Rate for Payer: PHCS PPO |
$270.63
|
| Rate for Payer: Three Rivers PPO |
$207.11
|
| Rate for Payer: TriWest Veterans Administration |
$160.17
|
| Rate for Payer: United Healthcare Commercial |
$240.25
|
| Rate for Payer: United Healthcare Medicare |
$160.17
|
| Rate for Payer: WINHealth Partners Commercial |
$270.63
|
| Rate for Payer: Wise Provider Network Commercial |
$262.34
|
|
|
AIRWAY EXCHANGE CATH 8FR
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Aetna of WY Medicare |
$138.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$121.80
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$115.71
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$121.80
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$121.80
|
| Rate for Payer: WINHealth Partners Commercial |
$205.80
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
AIRWAY EXCHANGE CATH 8FR
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$205.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$201.60
|
| Rate for Payer: Altius Commercial |
$201.60
|
| Rate for Payer: Beech Street Commercial |
$205.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$172.41
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$203.70
|
| Rate for Payer: Cigna of WY Commercial |
$205.80
|
| Rate for Payer: Entrust Commercial |
$199.50
|
| Rate for Payer: First Choice Health Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$199.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$138.60
|
| Rate for Payer: HealthUtah PPO |
$210.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$203.70
|
| Rate for Payer: Multiplan Medicare/VA |
$131.67
|
| Rate for Payer: One Health Plan of WY PPO |
$205.80
|
| Rate for Payer: PacificSource Commercial |
$189.00
|
| Rate for Payer: PHCS PPO |
$205.80
|
| Rate for Payer: Three Rivers PPO |
$157.50
|
| Rate for Payer: TriWest Veterans Administration |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$182.70
|
| Rate for Payer: United Healthcare Medicare |
$138.60
|
| Rate for Payer: WINHealth Partners Commercial |
$199.50
|
| Rate for Payer: Wise Provider Network Commercial |
$199.50
|
|
|
ALARIS BLOOD SET 2477-0007
|
Facility
|
OP
|
$21.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.41
|
| Rate for Payer: Aetna of WY Medicare |
$14.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.98
|
| Rate for Payer: Altius Commercial |
$20.98
|
| Rate for Payer: Beech Street Commercial |
$21.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.94
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.19
|
| Rate for Payer: Cigna of WY Commercial |
$21.41
|
| Rate for Payer: Entrust Commercial |
$20.76
|
| Rate for Payer: First Choice Health Commercial |
$20.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.67
|
| Rate for Payer: HealthUtah PPO |
$21.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.19
|
| Rate for Payer: Multiplan Medicare/VA |
$12.04
|
| Rate for Payer: One Health Plan of WY PPO |
$21.41
|
| Rate for Payer: PacificSource Commercial |
$19.66
|
| Rate for Payer: PHCS PPO |
$21.41
|
| Rate for Payer: Three Rivers PPO |
$16.39
|
| Rate for Payer: TriWest Veterans Administration |
$12.67
|
| Rate for Payer: United Healthcare Commercial |
$19.01
|
| Rate for Payer: United Healthcare Medicare |
$12.67
|
| Rate for Payer: WINHealth Partners Commercial |
$21.41
|
| Rate for Payer: Wise Provider Network Commercial |
$20.76
|
|
|
ALARIS BLOOD SET 2477-0007
|
Facility
|
IP
|
$21.85
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.70 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$20.98
|
| Rate for Payer: Altius Commercial |
$20.98
|
| Rate for Payer: Beech Street Commercial |
$21.41
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$17.94
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.19
|
| Rate for Payer: Cigna of WY Commercial |
$21.41
|
| Rate for Payer: Entrust Commercial |
$20.76
|
| Rate for Payer: First Choice Health Commercial |
$20.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.42
|
| Rate for Payer: HealthUtah PPO |
$21.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.19
|
| Rate for Payer: Multiplan Medicare/VA |
$13.70
|
| Rate for Payer: One Health Plan of WY PPO |
$21.41
|
| Rate for Payer: PacificSource Commercial |
$19.66
|
| Rate for Payer: PHCS PPO |
$21.41
|
| Rate for Payer: Three Rivers PPO |
$16.39
|
| Rate for Payer: TriWest Veterans Administration |
$14.42
|
| Rate for Payer: United Healthcare Commercial |
$19.01
|
| Rate for Payer: United Healthcare Medicare |
$14.42
|
| Rate for Payer: WINHealth Partners Commercial |
$20.76
|
| Rate for Payer: Wise Provider Network Commercial |
$20.76
|
|
|
ALARIS IVAC SET 20 DROP (NEW)
|
Facility
|
OP
|
$12.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.25
|
| Rate for Payer: Aetna of WY Medicare |
$8.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.00
|
| Rate for Payer: Altius Commercial |
$12.00
|
| Rate for Payer: Beech Street Commercial |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.12
|
| Rate for Payer: Cigna of WY Commercial |
$12.25
|
| Rate for Payer: Entrust Commercial |
$11.88
|
| Rate for Payer: First Choice Health Commercial |
$11.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.25
|
| Rate for Payer: HealthUtah PPO |
$12.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.12
|
| Rate for Payer: Multiplan Medicare/VA |
$6.89
|
| Rate for Payer: One Health Plan of WY PPO |
$12.25
|
| Rate for Payer: PacificSource Commercial |
$11.25
|
| Rate for Payer: PHCS PPO |
$12.25
|
| Rate for Payer: Three Rivers PPO |
$9.38
|
| Rate for Payer: TriWest Veterans Administration |
$7.25
|
| Rate for Payer: United Healthcare Commercial |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$7.25
|
| Rate for Payer: WINHealth Partners Commercial |
$12.25
|
| Rate for Payer: Wise Provider Network Commercial |
$11.88
|
|
|
ALARIS IVAC SET 20 DROP (NEW)
|
Facility
|
IP
|
$12.50
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.00
|
| Rate for Payer: Altius Commercial |
$12.00
|
| Rate for Payer: Beech Street Commercial |
$12.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$8.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.12
|
| Rate for Payer: Cigna of WY Commercial |
$12.25
|
| Rate for Payer: Entrust Commercial |
$11.88
|
| Rate for Payer: First Choice Health Commercial |
$11.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.25
|
| Rate for Payer: HealthUtah PPO |
$12.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.12
|
| Rate for Payer: Multiplan Medicare/VA |
$7.84
|
| Rate for Payer: One Health Plan of WY PPO |
$12.25
|
| Rate for Payer: PacificSource Commercial |
$11.25
|
| Rate for Payer: PHCS PPO |
$12.25
|
| Rate for Payer: Three Rivers PPO |
$9.38
|
| Rate for Payer: TriWest Veterans Administration |
$8.25
|
| Rate for Payer: United Healthcare Commercial |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$8.25
|
| Rate for Payer: WINHealth Partners Commercial |
$11.88
|
| Rate for Payer: Wise Provider Network Commercial |
$11.88
|
|
|
ALARIS PCA SET 10800176
|
Facility
|
IP
|
$10.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.34
|
| Rate for Payer: Altius Commercial |
$10.34
|
| Rate for Payer: Beech Street Commercial |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.45
|
| Rate for Payer: Cigna of WY Commercial |
$10.55
|
| Rate for Payer: Entrust Commercial |
$10.23
|
| Rate for Payer: First Choice Health Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.11
|
| Rate for Payer: HealthUtah PPO |
$10.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.45
|
| Rate for Payer: Multiplan Medicare/VA |
$6.75
|
| Rate for Payer: One Health Plan of WY PPO |
$10.55
|
| Rate for Payer: PacificSource Commercial |
$9.69
|
| Rate for Payer: PHCS PPO |
$10.55
|
| Rate for Payer: Three Rivers PPO |
$8.08
|
| Rate for Payer: TriWest Veterans Administration |
$7.11
|
| Rate for Payer: United Healthcare Commercial |
$9.37
|
| Rate for Payer: United Healthcare Medicare |
$7.11
|
| Rate for Payer: WINHealth Partners Commercial |
$10.23
|
| Rate for Payer: Wise Provider Network Commercial |
$10.23
|
|
|
ALARIS PCA SET 10800176
|
Facility
|
OP
|
$10.77
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.55
|
| Rate for Payer: Aetna of WY Medicare |
$7.11
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.34
|
| Rate for Payer: Altius Commercial |
$10.34
|
| Rate for Payer: Beech Street Commercial |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.84
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.45
|
| Rate for Payer: Cigna of WY Commercial |
$10.55
|
| Rate for Payer: Entrust Commercial |
$10.23
|
| Rate for Payer: First Choice Health Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.25
|
| Rate for Payer: HealthUtah PPO |
$10.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.45
|
| Rate for Payer: Multiplan Medicare/VA |
$5.93
|
| Rate for Payer: One Health Plan of WY PPO |
$10.55
|
| Rate for Payer: PacificSource Commercial |
$9.69
|
| Rate for Payer: PHCS PPO |
$10.55
|
| Rate for Payer: Three Rivers PPO |
$8.08
|
| Rate for Payer: TriWest Veterans Administration |
$6.25
|
| Rate for Payer: United Healthcare Commercial |
$9.37
|
| Rate for Payer: United Healthcare Medicare |
$6.25
|
| Rate for Payer: WINHealth Partners Commercial |
$10.55
|
| Rate for Payer: Wise Provider Network Commercial |
$10.23
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [9676]
|
Facility
|
OP
|
$19.59
|
|
|
Service Code
|
NDC 6898264302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.20
|
| Rate for Payer: Aetna of WY Medicare |
$12.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.81
|
| Rate for Payer: Altius Commercial |
$18.81
|
| Rate for Payer: Beech Street Commercial |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.00
|
| Rate for Payer: Cigna of WY Commercial |
$19.20
|
| Rate for Payer: Entrust Commercial |
$18.61
|
| Rate for Payer: First Choice Health Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.36
|
| Rate for Payer: HealthUtah PPO |
$19.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.00
|
| Rate for Payer: Multiplan Medicare/VA |
$10.79
|
| Rate for Payer: One Health Plan of WY PPO |
$19.20
|
| Rate for Payer: PacificSource Commercial |
$17.63
|
| Rate for Payer: PHCS PPO |
$19.20
|
| Rate for Payer: Three Rivers PPO |
$14.69
|
| Rate for Payer: TriWest Veterans Administration |
$11.36
|
| Rate for Payer: United Healthcare Commercial |
$17.04
|
| Rate for Payer: United Healthcare Medicare |
$11.36
|
| Rate for Payer: WINHealth Partners Commercial |
$19.20
|
| Rate for Payer: Wise Provider Network Commercial |
$18.61
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION [9676]
|
Facility
|
IP
|
$19.59
|
|
|
Service Code
|
NDC 6898264302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.81
|
| Rate for Payer: Altius Commercial |
$18.81
|
| Rate for Payer: Beech Street Commercial |
$19.20
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.00
|
| Rate for Payer: Cigna of WY Commercial |
$19.20
|
| Rate for Payer: Entrust Commercial |
$18.61
|
| Rate for Payer: First Choice Health Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.93
|
| Rate for Payer: HealthUtah PPO |
$19.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.00
|
| Rate for Payer: Multiplan Medicare/VA |
$12.28
|
| Rate for Payer: One Health Plan of WY PPO |
$19.20
|
| Rate for Payer: PacificSource Commercial |
$17.63
|
| Rate for Payer: PHCS PPO |
$19.20
|
| Rate for Payer: Three Rivers PPO |
$14.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.93
|
| Rate for Payer: United Healthcare Commercial |
$17.04
|
| Rate for Payer: United Healthcare Medicare |
$12.93
|
| Rate for Payer: WINHealth Partners Commercial |
$18.61
|
| Rate for Payer: Wise Provider Network Commercial |
$18.61
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
OP
|
$15.74
|
|
|
Service Code
|
NDC 6851652141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Aetna of WY Medicare |
$10.39
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.11
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.13
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$8.67
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$9.13
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare |
$9.13
|
| Rate for Payer: WINHealth Partners Commercial |
$15.43
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
IP
|
$16.11
|
|
|
Service Code
|
NDC 6898262302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.47
|
| Rate for Payer: Altius Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.63
|
| Rate for Payer: Cigna of WY Commercial |
$15.79
|
| Rate for Payer: Entrust Commercial |
$15.30
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.63
|
| Rate for Payer: HealthUtah PPO |
$16.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.63
|
| Rate for Payer: Multiplan Medicare/VA |
$10.10
|
| Rate for Payer: One Health Plan of WY PPO |
$15.79
|
| Rate for Payer: PacificSource Commercial |
$14.50
|
| Rate for Payer: PHCS PPO |
$15.79
|
| Rate for Payer: Three Rivers PPO |
$12.08
|
| Rate for Payer: TriWest Veterans Administration |
$10.63
|
| Rate for Payer: United Healthcare Commercial |
$14.02
|
| Rate for Payer: United Healthcare Medicare |
$10.63
|
| Rate for Payer: WINHealth Partners Commercial |
$15.30
|
| Rate for Payer: Wise Provider Network Commercial |
$15.30
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
IP
|
$15.74
|
|
|
Service Code
|
NDC 6851652141
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.43
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.11
|
| Rate for Payer: Altius Commercial |
$15.11
|
| Rate for Payer: Beech Street Commercial |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.27
|
| Rate for Payer: Cigna of WY Commercial |
$15.43
|
| Rate for Payer: Entrust Commercial |
$14.95
|
| Rate for Payer: First Choice Health Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.39
|
| Rate for Payer: HealthUtah PPO |
$15.74
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.27
|
| Rate for Payer: Multiplan Medicare/VA |
$9.87
|
| Rate for Payer: One Health Plan of WY PPO |
$15.43
|
| Rate for Payer: PacificSource Commercial |
$14.17
|
| Rate for Payer: PHCS PPO |
$15.43
|
| Rate for Payer: Three Rivers PPO |
$11.80
|
| Rate for Payer: TriWest Veterans Administration |
$10.39
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare |
$10.39
|
| Rate for Payer: WINHealth Partners Commercial |
$14.95
|
| Rate for Payer: Wise Provider Network Commercial |
$14.95
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION [7357]
|
Facility
|
OP
|
$16.11
|
|
|
Service Code
|
NDC 6898262302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$16.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.79
|
| Rate for Payer: Aetna of WY Medicare |
$10.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$15.47
|
| Rate for Payer: Altius Commercial |
$15.47
|
| Rate for Payer: Beech Street Commercial |
$15.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$13.23
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.63
|
| Rate for Payer: Cigna of WY Commercial |
$15.79
|
| Rate for Payer: Entrust Commercial |
$15.30
|
| Rate for Payer: First Choice Health Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.34
|
| Rate for Payer: HealthUtah PPO |
$16.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.63
|
| Rate for Payer: Multiplan Medicare/VA |
$8.88
|
| Rate for Payer: One Health Plan of WY PPO |
$15.79
|
| Rate for Payer: PacificSource Commercial |
$14.50
|
| Rate for Payer: PHCS PPO |
$15.79
|
| Rate for Payer: Three Rivers PPO |
$12.08
|
| Rate for Payer: TriWest Veterans Administration |
$9.34
|
| Rate for Payer: United Healthcare Commercial |
$14.02
|
| Rate for Payer: United Healthcare Medicare |
$9.34
|
| Rate for Payer: WINHealth Partners Commercial |
$15.79
|
| Rate for Payer: Wise Provider Network Commercial |
$15.30
|
|
|
ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
J7620
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$19.60
|
| Rate for Payer: Aetna of WY Medicare |
$0.20
|
| Rate for Payer: Beech Street Commercial |
$19.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.40
|
| Rate for Payer: Cigna of WY Commercial |
$19.60
|
| Rate for Payer: First Choice Health Commercial |
$18.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.20
|
| Rate for Payer: HealthUtah PPO |
$20.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.40
|
| Rate for Payer: Multiplan Medicare/VA |
$0.17
|
| Rate for Payer: One Health Plan of WY PPO |
$19.60
|
| Rate for Payer: PacificSource Commercial |
$18.00
|
| Rate for Payer: PHCS PPO |
$19.00
|
| Rate for Payer: Three Rivers PPO |
$15.00
|
| Rate for Payer: TriWest Veterans Administration |
$0.20
|
| Rate for Payer: United Healthcare Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicare |
$0.20
|
| Rate for Payer: WINHealth Partners Commercial |
$19.00
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [3850]
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Aetna of WY Medicare |
$1.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.03
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$0.98
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
| Rate for Payer: WINHealth Partners Commercial |
$1.73
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
ALBUTEROL SULFATE 1.25 MG/3 ML SOLUTION FOR NEBULIZATION [3850]
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1.70
|
| Rate for Payer: Altius Commercial |
$1.70
|
| Rate for Payer: Beech Street Commercial |
$1.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.45
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.72
|
| Rate for Payer: Cigna of WY Commercial |
$1.73
|
| Rate for Payer: Entrust Commercial |
$1.68
|
| Rate for Payer: First Choice Health Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.17
|
| Rate for Payer: HealthUtah PPO |
$1.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.72
|
| Rate for Payer: Multiplan Medicare/VA |
$1.11
|
| Rate for Payer: One Health Plan of WY PPO |
$1.73
|
| Rate for Payer: PacificSource Commercial |
$1.59
|
| Rate for Payer: PHCS PPO |
$1.73
|
| Rate for Payer: Three Rivers PPO |
$1.33
|
| Rate for Payer: TriWest Veterans Administration |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$1.17
|
| Rate for Payer: WINHealth Partners Commercial |
$1.68
|
| Rate for Payer: Wise Provider Network Commercial |
$1.68
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [2418]
|
Facility
|
OP
|
$0.38
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.37
|
| Rate for Payer: Aetna of WY Medicare |
$0.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.36
|
| Rate for Payer: Beech Street Commercial |
$0.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.37
|
| Rate for Payer: Cigna of WY Commercial |
$0.37
|
| Rate for Payer: Entrust Commercial |
$0.36
|
| Rate for Payer: First Choice Health Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.22
|
| Rate for Payer: HealthUtah PPO |
$0.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.21
|
| Rate for Payer: One Health Plan of WY PPO |
$0.37
|
| Rate for Payer: PacificSource Commercial |
$0.34
|
| Rate for Payer: PHCS PPO |
$0.37
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.22
|
| Rate for Payer: United Healthcare Commercial |
$0.33
|
| Rate for Payer: United Healthcare Medicare |
$0.22
|
| Rate for Payer: WINHealth Partners Commercial |
$0.37
|
| Rate for Payer: Wise Provider Network Commercial |
$0.36
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION [2418]
|
Facility
|
IP
|
$0.38
|
|
|
Service Code
|
HCPCS J7613
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.37
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.36
|
| Rate for Payer: Beech Street Commercial |
$0.37
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.31
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.37
|
| Rate for Payer: Cigna of WY Commercial |
$0.37
|
| Rate for Payer: Entrust Commercial |
$0.36
|
| Rate for Payer: First Choice Health Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.25
|
| Rate for Payer: HealthUtah PPO |
$0.38
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.37
|
| Rate for Payer: Multiplan Medicare/VA |
$0.24
|
| Rate for Payer: One Health Plan of WY PPO |
$0.37
|
| Rate for Payer: PacificSource Commercial |
$0.34
|
| Rate for Payer: PHCS PPO |
$0.37
|
| Rate for Payer: Three Rivers PPO |
$0.29
|
| Rate for Payer: TriWest Veterans Administration |
$0.25
|
| Rate for Payer: United Healthcare Commercial |
$0.33
|
| Rate for Payer: United Healthcare Medicare |
$0.25
|
| Rate for Payer: WINHealth Partners Commercial |
$0.36
|
| Rate for Payer: Wise Provider Network Commercial |
$0.36
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
NDC 0054074287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.05
|
| Rate for Payer: Altius Commercial |
$18.05
|
| Rate for Payer: Beech Street Commercial |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.24
|
| Rate for Payer: Cigna of WY Commercial |
$18.42
|
| Rate for Payer: Entrust Commercial |
$17.86
|
| Rate for Payer: First Choice Health Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.41
|
| Rate for Payer: HealthUtah PPO |
$18.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.24
|
| Rate for Payer: Multiplan Medicare/VA |
$11.79
|
| Rate for Payer: One Health Plan of WY PPO |
$18.42
|
| Rate for Payer: PacificSource Commercial |
$16.92
|
| Rate for Payer: PHCS PPO |
$18.42
|
| Rate for Payer: Three Rivers PPO |
$14.10
|
| Rate for Payer: TriWest Veterans Administration |
$12.41
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
| Rate for Payer: United Healthcare Medicare |
$12.41
|
| Rate for Payer: WINHealth Partners Commercial |
$17.86
|
| Rate for Payer: Wise Provider Network Commercial |
$17.86
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
NDC 0781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.42
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.05
|
| Rate for Payer: Altius Commercial |
$18.05
|
| Rate for Payer: Beech Street Commercial |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.24
|
| Rate for Payer: Cigna of WY Commercial |
$18.42
|
| Rate for Payer: Entrust Commercial |
$17.86
|
| Rate for Payer: First Choice Health Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.41
|
| Rate for Payer: HealthUtah PPO |
$18.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.24
|
| Rate for Payer: Multiplan Medicare/VA |
$11.79
|
| Rate for Payer: One Health Plan of WY PPO |
$18.42
|
| Rate for Payer: PacificSource Commercial |
$16.92
|
| Rate for Payer: PHCS PPO |
$18.42
|
| Rate for Payer: Three Rivers PPO |
$14.10
|
| Rate for Payer: TriWest Veterans Administration |
$12.41
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
| Rate for Payer: United Healthcare Medicare |
$12.41
|
| Rate for Payer: WINHealth Partners Commercial |
$17.86
|
| Rate for Payer: Wise Provider Network Commercial |
$17.86
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$10.65
|
|
|
Service Code
|
NDC 0173068224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$10.65 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.44
|
| Rate for Payer: Aetna of WY Medicare |
$7.03
|
| Rate for Payer: Altius Auto/Workers Compensation |
$10.22
|
| Rate for Payer: Altius Commercial |
$10.22
|
| Rate for Payer: Beech Street Commercial |
$10.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8.74
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.33
|
| Rate for Payer: Cigna of WY Commercial |
$10.44
|
| Rate for Payer: Entrust Commercial |
$10.12
|
| Rate for Payer: First Choice Health Commercial |
$10.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.12
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.18
|
| Rate for Payer: HealthUtah PPO |
$10.65
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.33
|
| Rate for Payer: Multiplan Medicare/VA |
$5.87
|
| Rate for Payer: One Health Plan of WY PPO |
$10.44
|
| Rate for Payer: PacificSource Commercial |
$9.58
|
| Rate for Payer: PHCS PPO |
$10.44
|
| Rate for Payer: Three Rivers PPO |
$7.99
|
| Rate for Payer: TriWest Veterans Administration |
$6.18
|
| Rate for Payer: United Healthcare Commercial |
$9.27
|
| Rate for Payer: United Healthcare Medicare |
$6.18
|
| Rate for Payer: WINHealth Partners Commercial |
$10.44
|
| Rate for Payer: Wise Provider Network Commercial |
$10.12
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$13.99
|
|
|
Service Code
|
NDC 6068766291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$13.71
|
| Rate for Payer: Aetna of WY Medicare |
$9.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$13.43
|
| Rate for Payer: Altius Commercial |
$13.43
|
| Rate for Payer: Beech Street Commercial |
$13.71
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.49
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$13.57
|
| Rate for Payer: Cigna of WY Commercial |
$13.71
|
| Rate for Payer: Entrust Commercial |
$13.29
|
| Rate for Payer: First Choice Health Commercial |
$13.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$13.29
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.11
|
| Rate for Payer: HealthUtah PPO |
$13.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$13.57
|
| Rate for Payer: Multiplan Medicare/VA |
$7.71
|
| Rate for Payer: One Health Plan of WY PPO |
$13.71
|
| Rate for Payer: PacificSource Commercial |
$12.59
|
| Rate for Payer: PHCS PPO |
$13.71
|
| Rate for Payer: Three Rivers PPO |
$10.49
|
| Rate for Payer: TriWest Veterans Administration |
$8.11
|
| Rate for Payer: United Healthcare Commercial |
$12.17
|
| Rate for Payer: United Healthcare Medicare |
$8.11
|
| Rate for Payer: WINHealth Partners Commercial |
$13.71
|
| Rate for Payer: Wise Provider Network Commercial |
$13.29
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER [17856]
|
Facility
|
OP
|
$18.80
|
|
|
Service Code
|
NDC 0054074287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.42
|
| Rate for Payer: Aetna of WY Medicare |
$12.41
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.05
|
| Rate for Payer: Altius Commercial |
$18.05
|
| Rate for Payer: Beech Street Commercial |
$18.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.43
|
| Rate for Payer: Cash Price |
$13.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.24
|
| Rate for Payer: Cigna of WY Commercial |
$18.42
|
| Rate for Payer: Entrust Commercial |
$17.86
|
| Rate for Payer: First Choice Health Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.90
|
| Rate for Payer: HealthUtah PPO |
$18.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.24
|
| Rate for Payer: Multiplan Medicare/VA |
$10.36
|
| Rate for Payer: One Health Plan of WY PPO |
$18.42
|
| Rate for Payer: PacificSource Commercial |
$16.92
|
| Rate for Payer: PHCS PPO |
$18.42
|
| Rate for Payer: Three Rivers PPO |
$14.10
|
| Rate for Payer: TriWest Veterans Administration |
$10.90
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
| Rate for Payer: United Healthcare Medicare |
$10.90
|
| Rate for Payer: WINHealth Partners Commercial |
$18.42
|
| Rate for Payer: Wise Provider Network Commercial |
$17.86
|
|
